188 I Reducing Risks for Mental Disorders BOX 6.6 Child Maltreatment Research on child maltreatment was stimulated in the early 19 reports of the "battered child" syndrome in the medical literature (\ Silverman, Steele, Droegemueller, and Silver, 1962). Since that time, rc studies in this field have generally focused on four types of child maltrec physical abuse, sexual abuse, emotional maltreatment, and child negl Child maltreatment serves as a useful illustration of the comp associated with identifying and addressing risk and protective factor: etiological chain encompassing both social problems and mental disoi is both a social problem, with its own set of risk and protective factors risk factor in itself for several mental disorders. Etiology Although several key variables or risk factors have been associate child maltreatment, such as poverty, a parental history of abusive exper and parental psychopathology, research on the causes of child abu neglect suggests that no single variable can adequately explain the ori child maltreatment. The results of etiological studies are often conflictii the predictive power of single or combined variables, such as the ind characteristics of the parent, child, or environment alone, is limit* example, although a strong association has been shown between pove child abuse, the relationship is complex—most poor parents clearly abusive, and poverty alone is not a sufficient or even a necessary ante for child maltreatment. Models of child maltreatment have evolved from isolated cause-am models to approaches that consider multiple pathways and interactive among factors that contribute to child maltreatment. Recognizing the tance of situational factors has led to the development of conten multicausal interactive models that emphasize the sociocultural cor child maltreatment. Child maltreatment is now described less as an ind disorder or psychological disturbance, and more as a symptom of an e disturbance of childrearing, often within a context of other serious problems, such as alcoholism or antisocial behavior (Wolfe, 1991; B 1979; Starr, 1979). Although studies of abusive and nonabusive paren not detected significant personality differences, research on the interac abusive and nonabusive family processes has yielded important distir Abusive parents have unrealistic expectations of their children, tend 1 their own children's behavior as extremely stressful, and view themse inadequate or incompetent parents (Wolfe, 1991). The information in this box is based in part on Understanding Child Abuse and (CBASSE, 1993). (cor,e the child is too impaired or temperamentally difficult or because the parents lack responsiveness owing to their own lack of nurturing, mental disorder, or overwhelming environmental distress. Sameroff and Chandler (1975) have described this as the "continuum of the caretaking casualty"; at one end of this continuum isely resolved (Luthar, 1993)., the outcomes are quite variable. Some children develop anxiety disorders, some have school problems, and some develop depressive symptoms or disorders. Thus, at least for children and adolescents, preventive interventions targeting a single risk factor need to consider not a single diagnosis but a range of outcomes and a range of diagnoses.